DYNAMIC NAVIGATED TOTAL KNEE REPLACEMENT ALIGNMENT USING WHITESIDE’S LINE

J.M. Dillon; A. Gregori; A. Mennessier; F. Picard

doi:10.1302/0301-620X.90BSUPP_III.0900561c

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DYNAMIC NAVIGATED TOTAL KNEE REPLACEMENT ALIGNMENT USING WHITESIDE’S LINE

J.M. Dillon
A. Gregori
A. Mennessier
F. Picard

DYNAMIC NAVIGATED TOTAL KNEE REPLACEMENT ALIGNMENT USING WHITESIDE’S LINE

Dillon J, Gregori A, Mennessier A, Picard F. DYNAMIC NAVIGATED TOTAL KNEE REPLACEMENT ALIGNMENT USING WHITESIDE’S LINE. Orthop Procs. 2008;90-B(SUPP_III):561-562. doi:10.1302/0301-620X.90BSUPP_III.0900561c

Dillon, J.M., et al. “DYNAMIC NAVIGATED TOTAL KNEE REPLACEMENT ALIGNMENT USING WHITESIDE’S LINE.” Orthopaedic Proceedings, vol. 90-B, no. SUPP_III, 2008, pp. 561-562., https://doi.org/10.1302/0301-620X.90BSUPP_III.0900561c

Dillon, J., Gregori, A., Mennessier, A., & Picard, F. (2008). DYNAMIC NAVIGATED TOTAL KNEE REPLACEMENT ALIGNMENT USING WHITESIDE’S LINE. Orthopaedic Proceedings, 90-B(SUPP_III), 561-562. https://doi.org/10.1302/0301-620X.90BSUPP_III.0900561c

Dillon, J., Gregori, A., Mennessier, A. and Picard, F. (2008) “DYNAMIC NAVIGATED TOTAL KNEE REPLACEMENT ALIGNMENT USING WHITESIDE’S LINE.” Orthopaedic Proceedings, 90-B(SUPP_III), pp. 561-562. Available at: https://doi.org/10.1302/0301-620X.90BSUPP_III.0900561c

Dillon, J.M., A. Gregori, A. Mennessier, and F. Picard. “DYNAMIC NAVIGATED TOTAL KNEE REPLACEMENT ALIGNMENT USING WHITESIDE’S LINE.” Orthopaedic Proceedings 90-B, no. SUPP_III (2008): 561-562. https://doi.org/10.1302/0301-620X.90BSUPP_III.0900561c

Dillon J, Gregori A, Mennessier A, Picard F. DYNAMIC NAVIGATED TOTAL KNEE REPLACEMENT ALIGNMENT USING WHITESIDE’S LINE. Orthop Procs. 2008 Aug 1;90-B(SUPP_III):561-562. https://doi.org/10.1302/0301-620X.90BSUPP_III.0900561c

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Abstract

Computer technology allows real time evaluation of knee behaviour throughout flexion. These measurements reflect tibial rotation about the femoral condyles, patellar tracking and soft tissue balance throughout surgery. An understanding of intraoperative kinematics allows accurate adjustment of TKR positioning. We studied computer navigation with the femoral component aligned to Whiteside’s line.

We used CT free navigation during TKR for 71 end-stage osteoarthritic patients. Patients demographics: 29 right–42 left; 44 female −27 male; age 70.4 years (+/− 8.4); mean BMI 30.8 (+/− 4.7; 23.2–48.6); Oxford score: 43 +/− 7.7 (28–58). Preoperatively, 57/71 knees were varus knees, 1 well-aligned and 13 valgus; 75% were cruciate retaining and 25% were posterior stabilised knees.

During surgery the frontal femorotibial or Hip-Knee-Ankle (HKA) angle was measured from maximum extension through 30°,60° and 90° of flexion. Measurements of the femoro tibial angles (HKA) in 0°, 30°, 60° and 90° of knee flexion before and after TKR were collected. No patella was replaced. We compared the kinematics of each knee. Femoral component rotation was 2.06° external rotation +/−1.32° (−1°; 5°) referenced from the dorsal condylar axis. Analysis divided the 71 patients into three groups:

When the femoral component was placed between 1° internal rotation and 0° of external rotation (7 patients) HKA tended to flex into valgus.
When the femoral component was placed between 1° and 3° of external rotation (45 patients) HKA tended to remain in neutral alignment (close to the mechanical axis).
When the femoral component was placed between 3° and 5°of external rotation (19 patients) HKA tended to flex into varus.

Whiteside’s line allows to correctly externally rotate the femoral component. According to our results White-side’s line is slightly less than 3° external rotation (2.06° +/−1.32°) and best tracking arises with a rotational value of slightly less than 3° external rotation.

A combination of Whiteside’s line and computer assisted navigation optimizes femoral component rotational placement.

Correspondence should be addressed to Mr K. Deep, General Secretary CAOS UK, 82 Windmill Road, Gillingham, Kent ME7 5NX UK. E Mail: caosuk@gmail.com